Two Kenyas and a Collect

We hear in America about "two Maines" and "two Vineyards." In Kenya, we also hear about disparate (some would say desperate) economies. Nairobi appears to be bustling, but we are told the safari business is still struggling and crime is increasing. The price of food has more than doubled here since last winter, but no one in Maseno has seen an increase in income, very few are employed, and many of those have not been paid for two months. The bean and corn fields look lush from the road, but the harvest is both late and disappointing. For the first time in years, there are not enough beans, and there is talk of importing corn.

Emmah explains it simply, "The long rains made it hard to grow good beans, and we did not have enough money this year to buy fertilizer for the corn." On Monday, after a long hot day walking through corn fields to make home visits, we stopped in nearby Luanda. It was market day. Our two volunteer HIV/AIDS community health workers, both single mothers, came back empty-handed: "The tomatoes and beans were too expensive. There is no corn. We'll have ugali (boiled cornmeal) again tonight." Yet Kenya is not Zimbabwe, not Thailand, not Mumbai.

Kyrie eleison, Christe eleison, Kyrie eleison.

"Almighty and gracious Father, we give thee thanks for the fruits of the earth in their season and for the labors of those who harvest them. Make us, we beseech thee, faithful stewards of thy great bounty, for the provision of our necessities and the relief of all who are in need... Amen." (Thanksgiving Collect, The Book of Common Prayer)

Silence

...is not always golden.

Sometimes it is a reflection of a high fever, like the 106F/41.1C recorded for Jesca, a sweet three-year-old who looks a lot like my granddaughter. Fortunately, her mother brought her to the hospital in time for us to put her on IV fluids and quinine for malaria. Mama Jesca's once-convulsing child is recovering and will go home tomorrow.

Sometimes it is an expression of pain. Joab, 9, was dropped off at the outpatient department yesterday after he had all but severed his baby finger with a panga while cutting grass. Showing no physical signs of shock, he walked quietly to our minor (operating) theatre for a tetanus shot, amputation and discharge.

Sometimes it precedes (and follows) the death rattles we witnessed in a two-year-old admitted yesterday. "She was perfect when God gave her to us," explained her father. "Now God wants to take her back." He then described a year of Nora's recurrent "boils," fevers, weakness -- and her intermittent treatment with herbal remedies. Three weeks ago, he said, Nora developed another fever, plus a stiff neck, but no boils. She died an hour after admission.

Silence is a time to pray. We didn't make it to church yesterday, but we certainly prayed.

Careful what you wish for...

According to the neighbors, we have had intermittent power and water for almost a year in Maseno. One of my assignments at the hospital is to "help improve nursing standards." The nurses and I have met several times. In an effort to better understand their roles before presuming to help them "improve" anything, I invited the charge nurses to share their own concerns and suggestions. "Better staffing" was answer number one, a response we'd hear from nurses at any hospital, at any place in the world. After that, the answers became more particular to Maseno:

Jik/bleach, gloves, rubber aprons and boots for infection control. (Back-ordered Jik. Can't afford the other items.)

Electricity. (It was out for 72 consecutive hours last week.)

Water. (None on the wards since July, it began flowing from the spigots again today. Yes, Mama, this, too shall pass.)

Foreskin Follies

That's what the doctor calls the current "occupation" of Maseno Hospital. Eighty 13-year-old boys are here for five days of education and circumcision, a pilot project funded by NGO's and facilitated by the CCC, in a well-documented effort to reduce the spread of HIV/ AIDS in Kenya. Three more waves of eighty adolescents each are scheduled to come during the next three weeks. A gaily-striped tent has been erected on the hospital lawn, and colorful plastic mattresses have been spread, wall-to-wall, on the floor of Pediatrics.

Fortunately, the hospital census is down, but the patients we have are sicker than ever. Among others, 80-year-old Truphena was admitted today. Her daughter brought her in after a young mentally-ill grandson had stabbed Truphena twice in the chest and tried to strangle her.

Phoebe Leah, 28, has been here for three days with her two-year-old son. Both are weak and listless, wasted by AIDS. Mama weights 35 kg, and Zedekiah weighs 7 kg. (A kilogram is 2.2 pounds; you can do the calculations.) Phoebe suffers from oral thrush and Kaposi's sarcoma; she also has KS lesions on her swollen right leg. The only treatment we have for KS is vincristine IV. She needs to be stronger before we administer it. Zedekiah is not walking, not talking and not smiling. His healthy 7-year old brother is being cared for by a grandmother. A middle child died three years ago. Because Zedekiah and his mother have AIDS, they were turned out of the house by his grandmother and his (HIV-positive) father -- who has another wife. Phoebe Leah and her youngest live in a shed on the edge of the property. She is too sick to work; whatever Phoebe is given to eat, she gives to her son. It isn't enough.
Benson, 10 years old, presented almost two weeks ago with a fever and pancytopenia. He cannot hear or speak, and his father is dead, so his mama spends most of her days at the hospital with him. She agreed to have her son tested for HIV since Benson had had a transfusion as a baby. He is HIV-positive. Since he is the middle child of three and his father had died, we needed to err on the side of caution: Mama and her other children were advised they should be tested. Sadly, all of them are HIV-positive. Fortunately, the CCC here offers excellent counseling and free anti-retroviral medications. But Benson is still spiking temperatures, and we cannot determine the cause. Pneumonias, aplastic anemia and malaria have been ruled out; he has been started on anti-TB meds. Perhaps he has an empyema?

Philip, 17, was brought by his mother to the Outpatient Department in the middle of the morning. He had fallen, hard, two days ago on a playing field at school and was complaining of abdominal pain. Ultrasound examination revealed a lacerated liver; we sent him by ambulance to Provincial Hospital in Kisumu where there is a surgeon.

Grace, 26, was admitted via the CCC this afternoon in a psychotic state. After 200 mg. of Thorazine and an injection of Valium, she was still combative. I foolishly forgot I was wearing my glasses while assisting with her examination. Grace managed to yank them off my face and crumple them with one bare hand. That's not quite the reason I anticipated I'd need a second pair, but I'm glad I packed both. Grace will be transferred to a psychiatric hospital tomorrow.

Tomorrow Kwan Kew Lai, an infectious disease physician from Boston, and I will go with Dr. Hardison and the mobile medical van to Ekwanda between morning and afternoon rounds. Our housemates Ralph (a UConn medical student) and Sue (a Boston EMT) will be leaving the hospital early to go on safari to the Maasai Mara. We may find our rambunctious pediatrics unit is somewhat more subdued by the time we all return.

Sweet Spirit

If it's Wednesday, it must be... Chapel. I am always grateful to walk to St. Philip's in the early morning sunshine. Primary school students, hospital staff members and farmers alike call out, "Habari, Mama/Daktari/Sister!" as we pass one another along the road. I crossed the theological college campus a few minutes late today and heard the now-familiar rhythmic a capella rumble of the first hymn through the open windows: "There's a sweet, sweet spirit in this place." Dorcas gave the homily, a moving message about empowerment, encouraging us to fully use the gifts/talents God gives us. Eucharist is always both personal and corporate, and it is a joy to sink into the comfort and company of all faithful people in the tiny red brick chapel that reminds me of home.

One week from tomorrow most of my family will gather together for Thanksgiving. Half a world away, I will be working at the hospital and missing, but thinking gratefully of, them all. We've scheduled our own holiday dinner (chicken, mashed potatoes, gravy, sukuma wiki/greens, baked pumpkin and mango pie) for Sunday, four days ahead of America's. The Pilgrims never landed on Kenya's shores, of course, but the authorities here seem to routinely invent new national holidays. The Hardisons and I decided we could be just as arbitrary and moved Thanksgiving up a few days to suit our patients' (OK, and our own) needs.

So Happy Holidays, Everyone! In spite of pain and poverty, illness and anxiety, we have much to be thankful for, the world over. I am especially grateful for your love and your prayers, and so are the people of Maseno. There truly is a sweet, sweet spirit in this place. We feel blessed to be able share it, and we send our love and prayers to you, as well. Asante sana.

All I Really Need to Know I'm Learning in Kenya

(with apologies and thanks to Robert Fulghum)

(1) Share everything. Some people may take advantage of you, but others may not starve tonight if you simply share your last bananas. (This applies to people. The monkeys are doing fine.)

(2) Play fair. Although "African time" is often two hours later than "American time," continue to show up for your appointments as scheduled. You'll meet some fascinating folks while you wait.

(3) Don't hit people. Their pangas are likely to be bigger than yours.

(4) Put things back where you found them. Especially the slug you found crawling out of the sink drain. He needs water, too, and you don't want to find him in your drinking glass.

(5) Clean up your own mess. Scraps go to the kukus, and absolutely everything else gets recycled.

(6) Speaking of kukus, jog cautiously. It is easy to trample a baby chick -- or trip over a rut, for that matter -- by dawn's early light.

(7) Don't take things that are not yours. Someone else probably will, and you won't want to be blamed for it. (Remember the pangas.)

(8) Say you're sorry when you hurt somebody, even if it's a patient whose limb you really had to manipulate to determine mobility. And especially if you asked a foolish question like, "Are you the patient's mama?" and were told, "No. I'm the co-wife."

(9) Wash your hands before you eat -- and afterward, too. There are often no utensils. It is also polite to pour the water and hold the bowl for the next person.

(10) Flush only when necessary. Water is precious. Flushing does not apply, however, in the "long drop." (Remember recycling.)

(11) Piki-pikis kill. Since no one wears a helmet here, piki-piki and panga victims are vying for beds in the hospital and morgue. Perhaps someone could send me some "Ban Mopeds" bumper stickers from the Vineyard...

(12) A little goes a long way, and it's remarkable what we can do without. A latex glove makes a perfectly good tourniquet, stones in plastic bags make reasonable ankle weights, a dried up Bic pen makes an excellent thermometer case, and empty toilet paper rolls make perfect drapery tiebacks.

(13) You don't need to speak Kiswahili to understand the universal language of love. Just watch a mama nursing her child.

(14) Warm cookies and milk are good for you. But Emmah's homemade maandazis are even better.

(15) Don't hog space. There's room for all of us. Even mosquitoes and termites and cockroaches have their places in the world. Preferably outside.

(16) Live a balanced life. Learn and think and work and play and sing and dance at least a little every day. Especially if you can sing with a Kenyan caller and dance to a Luhya drumbeat.

(17) Take an afternoon nap on your mat (OK, I'm still struggling with this one), preferably not in the equatorial sun.

(18) Watch out for matatus, boda-bodas and piki-pikis. They all hurtle along carrying 3-4 more times their authorized number of passengers -- and usually a few chickens and goats, besides.

(19) Hold hands (just with the same sex, please, in East Africa), and stick together. We can get along without electricity, but we can't get along without one another.

(20) A highway is not necessarily paved. Nor is it even two marked lanes. Nor would anyone notice if it were. So remember #19: hold hands and stick together -- and cross quickly.

(21) Don't believe everything you hear. Especially patient histories. The reasons are perfectly innocent and perfectly clear: (a) patients want to please medical professionals, and (b) the concept of time is not the same where different where people don't know their birth dates, where 9 AM means noon (at best), and where pain is tolerated until it's intolerable... i.e., "How long have you had chest pain?" Two weeks. "How long have you had vomiting?" Two weeks. "How long have you had fever?" Ayup: two weeks.

(22) Peepers and geese and antimalarial drugs can keep you awake all night. So can one pesky mosquito... Nets are good. Doom is better.

(23) Be aware of wonder. Wherever we are in God's world, from South Beach to Lake Victoria, there is great beauty to behold -- particularly in the eyes of children.

(24) Goldfish and hamsters and gerbils and white mice all die. So do we. But we die a whole lot faster if we are poor and hungry and unable to get medical care.

(25) God loves me and Y-E-W! (Thank you, Archbishop Tutu!)

Monkey See, Monkey Do

Well, we wondered when it would happen...

Yesterday we finished eating lunch between rounds and took our dishes to the kitchen. Just as we returned, we caught a vervet in the act of stealing a banana right off the dining room table! He had come in through the open window, perched on the top rung of a chair, and brazenly stretched out his long arm to neatly swipe one banana from the bunch. He started to peel it in front of our eyes before housemate Ralph shouted "NO!" and chased him out of the house (banana and all) with a rolled up newspaper.

The monkey obviously wasn't properly trained because he was unfazed by the chase. He leapt to the railing of our porch, cocked his head, finished peeling his prize, and smugly chomped it down, bite by happy bite. We watched in astonishment as his friends began gathering on the front lawn. The word was obviously out, and they were lining up for a chance to snitch our remaining bananas!

It's about 85 degrees here in the afternoon, but we're either going to have to close the dining room windows or else hide the bananas if we want to have any left for ourselves!

Snail Mail

My sainted father rued the day "real" correspondence began to be replaced by email. The longer I live in East Africa with dial-up internet, the more I concur with his assessment. On the other hand, snail mail takes 2-3 weeks to get to Kenya, and our packages are intercepted at Customs, never to be seen again.

But instant gratification isn't everything, and I am thankful to have received two pieces of snail mail in the month since my arrival in Maseno: an absentee ballot (alas, too late to be counted) and a wonderful letter from The Rev. John T. Braughler in Pittsburgh, PA -- the person perhaps most responsible for my being here.

Fifty years ago, Pastor Braughler was minister, teacher and role model to about 25 of us who met as preteens for two full years of Catechism classes at Good Shepherd Church in Monroeville, PA. He made Saturday mornings come alive, and he somehow got us through those painful, but formative, junior high years.

My faith life began to develop when I was a little girl in Vacation Bible School, but it blossomed when I was a gawky adolescent in Good Shepherd's Catechism class. To my delight, a friend and retired Lutheran minister found John Braughler's address for me just a few years ago. (Thank you, Richard!)

I had longed to thank Pastor Braughler personally for all he had done, all those years ago. Now I can thank him publicly, as well, for sending me the first snail mail I've received as an Episcopal missionary in Kenya. How appropriate that it came from a man who fostered the faith that has sustained me for 50 years!

Asante sana, Pastor Braughler. God's eternal peace to you and your family, and my eternal thanks for all you gave us... Amen.

P.S. In case anyone else remembers the Palmer method and still owns a (not necessarily quill) pen, the address here is Maseno Hospital, PO Box 116, Maseno 40105, Kenya. My email address is dianne.smith.rn@gmail.com. It is a gift to hear from everyone, by every means, and I will make every effort to reply.

Together, "Yes, we can!"

The hospital is full. Yesterday's morning and afternoon rounds simply merged into a somewhat chaotic 12-hour shift. I'm sure Dr. Hardison went home and worked some more. Although I brought a couple of texts back to Rotary House, my own research into the diseases-of-the-day didn't last; I quickly fell asleep.

The usual cries of roosters and hadada ibis roused us at dawn, however, so I've been reading this morning about some of our current patients' problems: cutaneous anthrax (contracted by a farmer with a sick cow), a medullary tumor (defined by CT scan in Kisumu and attributed -- incorrectly, per LP results -- to cryptococcal meningitis), lumbar TB and pyelonephritis, to name a few. Other patients are suffering from perhaps more-familiar, but equally debilitating, malaria, bacterial infections, cancer and CVA.

Our housemate Abraham returned last night from a week-long HIV seminar in Kisumu, bringing tales of the Obama election celebrations there. Kisumu is the third-largest city (behind Nairobi and Mombasa) in Kenya. Abraham said a huge TV screen was set up outside in the city center, traffic was blocked off, and thousands of people watched and sang and danced and hugged for hours, as the election returns came in. He also reported that there was no beer left in the city, but that it was a joyous, peaceful (no-panga!) time.

Here in Western Province, home of the Luo tribe, the daily greeting is no longer the perfunctory "Jambo; habariacu?" ("Hello; how are you?") It is now, simply, "Yes, we can!" as people clasp hands and smile. Barack Obama's father attended the nearby Maseno School (until he was kicked out, per our President-elect's first book). We frequently walk by it, en route to St. Philip's.

Election day and the ensuing national holiday were quiet on the hospital compound, but joy continues to show on the faces of Maseno. We all pray for Barack Obama, his family and advisors, our countries and the world. And we give thanks for the hope that is now in the hearts of many for the first time in their adult lives.

"Together we can!" was the theme of the CCC orphans' Christmas party here last year. I blogged about it at the time, and then again in the aftermath of Kenya's elections in December. TOGETHER, "Yes, we can..." Hm. Isn't that the concept of community Jesus was talking about awhile ago, too? Inside the hospital and outside in the world, renewed hope inspires all of us -- sick and well -- as we begin another day.

Ward IV/Pediatrics

Many of the kids admitted to Maseno Hospital have malaria and/or bacterial infections; most of them survive after we administer appropriate fluids, blood transfusions, anti-malarials and/or antibiotics. It's a miracle that we don't see more injured children here. The neighbors' kids play with real pangas (machetes) as four- and five-year-olds, chopping away at trees and stumps in our yard. They also use sticks as guns, just like kids do in the U.S., shrieking loud staccato "bam-bam-bam-bams" -- usually outside an open window as I futilely try to read. Fortunately, at least, they don't play with real guns.

We admitted a four-month-old baby yesterday, but he was quickly transferred to PGH, the public hospital in Kisumu, with extensive burns on his face and trunk. Jeremiah's five-year-old sister had been carrying him, to help her mama, but Rose wasn't strong enough. She accidentally dropped her brother into a vat of hot uggi (porridge) that was boiling over an open fire. It was a sadder-than-usual moment at Maseno Hospital. The baby was wailing in pain; his brown skin had been burned off, revealing pink and white second and third degree burns; the mama's tears were streaming down her face; and I could only imagine how upset (and splash-burned, too) Rose herself was.

Shortly before I arrived in Maseno, several children were admitted from an orphanage in Kakamega. Brought in by alert and caring guardians, the kids were treated here for salmonella and released. A major outbreak was averted. In the process, though, we heard a few of the kids' stories. One infant had been buried alive by her distraught mother; she was rescued by a neighbor and delivered to the orphanage for safety. Another was stunted in growth, due to lack of food and medical care as he grew up alone, without adult supervision. But it was heartwarming to learn that those kids have a safe place to live now, a place where they are cherished, as all children deserve.

Leah

Her mother brought her to the hospital three days ago. Leah's chief complaint was a headache. She said her husband had died in 1996, and she asked us to let her die, too. Leah, 36, was thin and somewhat listless, but her conversations (in Kiswahili) were animated. She had no pain except the headache, her vital signs were normal, and her chest and abdomen were clear. HIV positive with a CD4 count of 238, her malaria smear was negative, and her FHG (full hemogram/CBC) was normal; there are no chem screen panels in Maseno. With not much to go on, but given the host of infectious possibilities here, Dr. Hardison started her on the antibiotic Ceftriaxone. We watched and waited.

Yesterday her mother reported that Leah had diarrhea. Her chest was still clear. At the same time, her temperature began to spike, and she quickly became unresponsive. Within two hours, she was comatose. We weren't sure why, but Leah was slipping away in front of our eyes. Ralph, a visiting med student from U.Conn, performed his first lumbar puncture to perfection; Leah's spinal fluid came out clear and without undue pressure -- although we have no gauge here. It was sent to our lab and the results were returned quickly: no cryptococcus, but Leah's glucose level was less than 1/4 of normal. With no previous history, she had lapsed into a hypoglycemic coma!

I sat next to Leah's mama while Dr. Hardison administered a bolus of IV dextrose and ordered D50. Leah roused and was responsive within minutes. Her previously frightened mother hugged and kissed me: "Thank you, thank you, thank you, Sister." Equally joyous, I replied, "We need to thank Dr. Hardison. And God." Since Leah is still febrile, there is certainly more going on than "just" hypoglycemia -- which Dr. Hardison says he sees surprisingly often here. But at least we can now begin to tackle that problem... and then head for the weekly orphan feeding program and mobile medical clinic in Esiandumba.

Hymn 593 (ACK Songbook)

"Let us rejoice and be glad..." we sang at St. Philip's Chapel this morning, not long after the dawn of a new day in Kenya and, indeed, around the world. But we first sang, "Softly and tenderly Jesus is calling." Too soon and too sadly, I learned the reason.

We have no television or radio here at Rotary House; the internet was overloaded with traffic and inaccessible all night. As a result, I awakened happily to the sound of two cows lowing outside my window, rather than to the blaring blue light and cacophony of TV newscasts. The coffee was on before 6 AM since Emmah knows my Wednesday morning routine.

"Morning has broken," I hummed to myself as I walked down the long red road to St. Philip's. Maseno mamas were out early, gathering sticks for firewood; the men were lounging by their boda-boda's (bicycles), disappointed that I chose to walk the distance; and a few fortunate children were setting off for school in their distinctively-colored uniforms. Periodic outbursts of applause erupted from some of the houses along the road, hinting at the excitement in Luo-land as the US votes were being tallied. Today is a very special day, indeed, and even Kenya's Kikuyu president has astutely declared tomorrow a national holiday.

But for many people here, the days are much the same. They are days of serious struggle. Western Province is the second-poorest province in the country, and life is hard -- not just for our hospital patients. In the past nine months, since the post-election violence in Kenya, corn has doubled in price, rice has tripled, and the current crops won't be harvested until December. The cost of petrol/gasoline has skyrocketed, we are in the midst of yet another inexplicable water shortage (a municipal financial issue, definitely not a water table problem), and power outages are increasing.

Today was especially hard for Florence, a 25-year-old HIV-positive woman whose suckling third child was born eight months ago. Afterward, she went to the Maternal Child Health Center for family planning assistance, but she was eight weeks too late. Florence learned today that she is 24 weeks pregnant. She spent the morning in tears, anxious about how she'll be able to provide for her young family. Her husband is too sick to work.

Today was harder still for Christopher Ruto. A theological school student at St. Philip's, he is the father of twin toddlers and three older children. His beloved wife Rhoda died last night in a Nairobi hospital. She had been in a coma there for several weeks, after suffering a brain aneurysm. The whole school is in mourning, and so are we. Please pray for Rhoda's family.

The bishop's entourage arrived at a Mothers' Union meeting this afternoon. Bp. Simon Oketch came to congratulate the ladies on their participation in a new micro-lending program being provided by the Jubilee ministry of the Diocese of Massachusetts. "Let us rejoice and be glad," we sang again, between spontaneous "Obama" chants and Nan's "You go, Girls!" refrain.

After the meeting, a crowd of happily shrieking children drew my attention. They were hunkered down in the dirt together; I thought they might be playing marbles. Instead, I found them trapping termites beneath a plastic-bag anchored by rocks over a small patch of earth. When the bag was lifted, dozens of hands dove wildly into the pile of termites that had collected. The live afternoon snacks, wiggly wings and all, immediately disappeared into hungry mouths. (The wings were quickly spat out.)

Padre Richard's homily this morning was from I Peter 2:21. "Life is difficult," he said. "But Christ suffered, too, and He suffered for us. The cross of Christ shapes and sharpens us. It draws us closer to Him and to one another. Yes, 'softly and tenderly, Jesus is calling, calling for you and for me.'" For Rhoda and Florence and the kids eating crunchy live protein. For the new American president and his family, for the United States, for Kenya and for the world. Let us all draw closer together. "This is the day the Lord has made. Let us rejoice and be glad."

Birthday Present

Major celebrations are planned around the globe this month, the most important of which is my mother's birthday.

Your gift is online, Mama. Just click on www.picasaweb.google.com/dianne.smith.rn. (I'm sure she'll share with everyone. My mother is the kindest woman in the world.)

Birthday blessings, hugs and kisses -- from me and the giraffes! I love you.

Starfish Story

Philip was admitted last evening, just as we were finishing rounds. A shy, stunted young man, just a boy, really, he looked both younger, and somehow far older, than his 20 years. He was brought to us by a teacher in the community, a Rotarian who helped to organize the Jiggers Treatment Program at a school in Kwilhiba Parish. The teacher had learned about Philip from his neighbors. She went to his village to find and bring him to Maseno Hospital.

Philip's eyes were downcast. He was encrusted with layers of clay, and he smelled like sour dirt. Every centimeter of his malnourished body was disfigured by ichthyosis and by the swollen masses of lesions that are produced by "jiggers." Jiggers are caused by fleas in the soil. Their larvae infest and infect the skin, turning it to lumpy, painful shreds over time. We usually see the condition in patients' extremities, not enveloping their entire bodies. But Philip had been sleeping for years on the dirt floor, where jiggers dwell, of his one-room mud house. His legs were also swollen bilaterally -- perhaps by infected lesions, perhaps by elephantiasis. We will know after the lab results come in today.

Last night, we simply bathed Philip. Shocked into silence by disbelief and galvanized into action by grief, I lugged buckets of water to Ward I. We washed and rinsed Philip, sponged him for 15 minutes with a chemical treatment that will -- after repeated applications -- suffocate the jiggers, rinsed him again and helped him dry. Philip was quiet, compliant and understandably embarrassed. We then applied petroleum jelly to his entire body, in an effort to address the scaly skin around the shreds. Before finishing rounds, Dr. Hardison gave Philip clean clothing, beans and ugali (finely-ground cooked cornmeal) for supper, and gently tucked him into the first bed he may have ever slept in.

Philip's story is still piecing itself together, but he was orphaned at an early age. His father died before he was born, his mother soon thereafter, and he was raised by a grandmother who suffered from a progressive dementia. Philip tried to provide for her and for himself by cutting and selling firewood. His grandmother's condition deteriorated to the point that she was incontinent. They reportedly lived in squalor, their mud house caving in around them, their clay floor infested with bacteria and jiggers. His grandmother died before receiving any treatment, and Philip was left alone.

He is safe now, but frightened and overwhelmed. We pray that Philip will stay with us long enough to fully recover. He has been promised housing and a job in his village, guarding a kiosk/shop with a cement floor (hence, no jiggers). There's that Hope again, "that thing with feathers that never stops at all." But we have to wonder how many more Philips there are in the world... As Gerry reminded me last night, "He is our starfish."

[Please look it up if you don't remember the wonderful starfish allegory. I can't retell it now; thanks to your love and support, I will be leaving soon with the mobile medical team for the Saturday Orphan Program in Ebwali.]